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Background: Infertility has been identified as a global reproductive health concern with a greater
burden in countries with limited resources. It is also a major cause of marital instability and
affects the quality of life and wellbeing of the affected. Although in-vitro fertilization (IVF) has
been considered a definitive treatment of infertility, not all post-IVF outcomes are favorable. This
could be attributed to procedural issues as well as the patient‘s sociodemographic and clinical
characteristics. However, there is limited local data addressing the clinical characteristics that
affect early IVF outcomes among women seeking the services.
Objectives: This study aimed to determine clinical characteristics and early outcomes among
women undergoing in-vitro fertilization treatment at Mediheal Hospital and Fertility Center in
Eldoret, Kenya.
Methods: This was a one-year prospective cohort study involving 153 women undergoing invitro
fertilization as a definitive treatment for infertility at Mediheal Fertility Centre. The
participants were sampled consecutively over a nine-month accrual period and followed up at 2,
6, and 12 weeks of IVF treatment. Sociodemographic characteristics were collected using an
interviewer-administered questionnaire. Pregnancy tests, first and second (obstetric ultrasound
was done on the 2nd, 6th, and 12th week after IVF treatment to determine early clinical outcomes.
Data analysis conducted using R statistical computing software (R Core Team, 2017). Pearson
Chi-Square test and independent samples t-test were used to compare Clinical and
Sociodemographic Characteristics and early clinical outcomes. Logistic regression model was
used to assess the determinants of IVF success (critical value ≤0.05). Odds Ratios were computed
at 95% confidence interval.
Results: A total of 153 women with a mean age of 36.2 (± 5.7) years were enrolled. Majority, 140
(91.5%) were married, 132 (86.3%) had a tertiary level education and 109 (71.2%) had health
insurance and a median body mass index was 26.2 IQR: 23.5, 29.1) kg/m2. Primary infertility was
reported among 83 (54.2%) women, 120 (78.4%) had regular menstrual cycle, 71 (46.4%) had
regular coitus (>4 times a month) while 112 (73.2%) had reproductive disorders. On the first
follow-up visit (2 weeks post IVF) 8 women were lost to follow-up hence pregnancy tests was
done on 145 women of which 75 (49%) were positive and 70 (45.8%) were negative and were
dropped from the study. On the second visit (6 weeks post IVF) 5 women were lost to follow -up
leaving 70 women for an obstetric ultrasound of which 61(39.9 %) were normal pregnancies with
3 (4.3%) ectopic pregnancies and 6 (8.6% ) miscarriages. At the third visit (12 weeks post IVF),
all the 61 women returned for an obstetric ultrasound, with 52 (34%) being normal while 6 (9.8%)
had miscarriage, 2 (3.3%) had vanishing twins and 1 (1.6%) had blighted ovum. Although
majority of the assessed characteristics were not associated with early IVF outcomes, women with
a regular menstrual cycle (AOR=1.089; 95% CI: 0.741, 1.599) and primary infertility
(AOR=1.051; 0.748, 1.477) were more likely to have positive pregnancy tests on the first followup
visits. A normal BMI (AOR=2.216; 0.663, 7.405) and regular menstrual cycle (AOR=1.406;
0.398, 4.973) increased the likelihood of normal pregnancy after 12 weeks following IVF
treatment. Previous infertility treatment was significantly associated (p=0.032) with normal
pregnancy outcomes after 12 weeks of IVF treatment.
Conclusions: Majority of the women who seek IVF treatment are married for five or more years,
have a tertiary level of education, formally employed with health insurance and reproductive
disorders. The overall pregnancy success rate 12 weeks after IVF treatment at Mediheal fertility
centers is 34%. Previous infertility treatment is significantly associated with favorable early
clinical outcomes of IVF treatment.
Recommendations: More women should seek health insurance as a way of financing IVF
treatment. Previous fertility treatment should be encouraged prior to IVF treatment to improve
early clinical outcomes. Future studies should assess reasons for loss to follow-up and validate
this study‘s findings in a public healthcare facility. |
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